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Tytuł pozycji:

[Significance of Lipopolysaccharide Lipid A Gene Mutation of Extensively Drug-resistant Acinetobacter baumanii on Polymyxin Resistance and Its Influence on Treatment].

Tytuł :
[Significance of Lipopolysaccharide Lipid A Gene Mutation of Extensively Drug-resistant Acinetobacter baumanii on Polymyxin Resistance and Its Influence on Treatment].
Autorzy :
Mao HB; Department of Clinical Pharmacy, Kaifeng People's Hospital, Kaifeng 475000, China.
He M; Department of Clinical Pharmacy, the First Affiliated Hospital of Henan University, Kaifeng 475001, China.
He SN; School of Medicine, Henan University of Science and Technology, Luoyang 471003, China.
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Źródło :
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition [Sichuan Da Xue Xue Bao Yi Xue Ban] 2021 Jan; Vol. 52 (1), pp. 124-128.
Typ publikacji :
Journal Article
Język :
Chinese
Imprint Name(s) :
Original Publication: Chengdu Shi : Sichuan da xue xue bao (yi xue ban) bian ji bu, 2003-
MeSH Terms :
Acinetobacter Infections*/drug therapy
Acinetobacter baumannii*/genetics
Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Drug Resistance, Multiple, Bacterial/genetics ; Drug Synergism ; Humans ; Lipid A ; Lipopolysaccharides ; Microbial Sensitivity Tests ; Mutation ; Polymyxins/pharmacology
Contributed Indexing :
Keywords: Acinetobacter baumannii; Drug combination; Drug resistant; Genetic mutation; Polymyxin
Substance Nomenclature :
0 (Anti-Bacterial Agents)
0 (Lipid A)
0 (Lipopolysaccharides)
0 (Polymyxins)
Entry Date(s) :
Date Created: 20210121 Date Completed: 20210122 Latest Revision: 20210122
Update Code :
20210210
DOI :
10.12182/20210160208
PMID :
33474901
Czasopismo naukowe
Objective: To explore the significance of the resistance to polymyxin resistance of the extensively drug resistant Acinetobacter baumannii (XDRAB) lipopolysaccharide (LPS) lpx A , lpx C , lpx D and to screen appropriate combination therapy.
Methods: In the past two years, 72 XDRAB in the secretions of our patients were selected as the research object. According to the minimum inhibitory concentration (MIC) of the XDRAB strain on polymyxin, they were included in the drug resistance group and the sensitive group. The gene sequences of strains lpx A , lpx C , lpx D were compared with the standard strains to analyze gene mutations and compared the mutation rates in the drug resistant group and the sensitive group. The efficacy of the combination drugs was evaluated by microcheckerboard dilution method, including polymyxin+imipenem group, polymyxin+meropenem group, polymyxin+cefoperazone/sulbactam group, polymyxin+levofloxacin group, and polymyxin+fosfomycin group. Calculated the fractional inhibitory concentration (FIC) index of the combined medication regimen and compared the percentage of strains that exhibited synergistic, additive, irrelevant, and antagonistic effects.
Results: Tentyone were in the drug resistant group, accounting for 21 (29.17%,) and 51 were in the sensitive group, accounting for 70.83%. Some strains had mutations in lpx A , lpx C , lpx D genes. The mutation rate in the drug resistant group was 90.48%, which was significantly higher than 11.76% in the sensitive group, the difference was statistically significant ( P <0.05). The combined drug sensitivity test showed, compared with the polymyxin+fosfomycin group, the mycotin+fosfomycin group had a higher percentage of strains with synergistic FIC index in the polymyxin+imipenem group, the difference was statistically significant ( P <0.01).
Conclusion: XDRAB is resistant to polymyxin, which is related to mutations in LPS lipid A biosynthesis genes lpx A , lpx C , lpx D . Clinical treatment should adopt a combination of polymyxin+imipenem/meropenem and other drug combination to reduce the secondary infection of drug resistant bacteria.
(Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

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